Structural Characteristics of Novel Composite Hemostatic Sponges

Introduction: Hemostasis in parenchymal organs remains an issue in abdominal surgery. Effective hemostasis in modern operating rooms is achieved by various local hemostatic agents, which are often composite.

Objective: To investigate structural characteristics of novel composite hemostatic sponges.

Materials and methods: We compared samples of novel hemostatic sponges (with different weight ratios [15:85, 25:75, and 50:50] of marine collagen to sodium carboxymethylcellulose [Na-CMC]) developed by our team with local hemostatic agents used in clinical practice. There was a total of 7 study groups. All the samples were studied in transmitted light and underwent microphotography with subsequent morphometry. We performed scanning electron microscopy and measured fiber thickness (μm) and pore area (mm²).

Results: The largest pore areas were found in the group of samples developed by our team (with the lowest content of marine collagen, 15%), which was higher than in groups with sponges already introduced into clinical practice (1.5 times higher compared with groups 4 and 7 and 2.7 times higher than in group 6). In terms of fiber thickness, the highest values were observed in group 3 (Na-CMC/marine collagen ratio of 50:50).

Conclusions: The optimal ratio of collagen/Na-CMC in hemostatic sponges is 50:50, resulting in sufficient porosity and fiber thickness. Owing to these structural characteristics the sample demonstrated its high efficacy in animal studies.

1. Parkhisenko YuA, Vorontsov AK, Vorontsov KE, Bezaltynnykh AA. Analysis of the results of the surgical treatment of patients with trauma of the liver. Perspectives of Science & Education. 2018;(1):245–250. (In Russ.).

2. Hwang S, Na BG, Kim M, Won DH. Rescue fibrin glueinfiltrating hemostasis combined with hepatorrhaphy to control intractable postoperative bleeding from the liver cut surface. Ann Hepatobiliary Pancreat Surg. 2021;25(4):517–522. PMID: 34845124. PMCID: PMC8639305. https://doi.org/10.14701/ah-bps.2021.25.4.517

3. Herliana H, Yusuf HY, Laviana A, Wandawa G, Cahyanto A. Characterization and analysis of chitosan-gelatin composite-based biomaterial effectivity as local hemostatic agent: a systematic review. Polymers (Basel). 2023;15(3):575. PMID: 36771876. PMCID: PMC9920696. https://doi.org/10.3390/polym15030575

4. Lipatov VA, Tsilenko KS, Denisov AA, Kondakova PD. Studying the efficacy of local hemostatic agents in vivo. Innovative Medicine of Kuban. 2023;(2):34–39. (In Russ.). https://doi.org/10.35401/2541-9897-2023-26-2-34-39

5. Chiara O, Cimbanassi S, Bellanova G, et al. A systematic review on the use of topical hemostats in trauma and emergency surgery. BMC Surg. 2018;18(1):68. PMID: 30157821. PMCID: PMC6116382. https://doi.org/10.1186/s12893-018-0398-z

6. Hickman DA, Pawlowski CL, Sekhon UDS, Marks J, Gupta AS. Biomaterials and advanced technologies for hemostatic management of bleeding. Adv Mater. 2018;30(4):10.1002/ adma.201700859. PMID: 29164804. PMCID: PMC5831165. https://doi.org/10.1002/adma.201700859

7. Park YM, Seo HI, Kim JH, Yoon SP, Lee H, Lee MS. Clinical application of a new hemostatic material using mussel-inspired catecholamine hemostat: a pilot study. Ann Hepatobiliary Pancreat Surg. 2022;26(1):98–103. PMID: 34840145. PMCID: PMC8901974. https://doi.org/10.14701/ahbps.21-077

8. Huang H, Chen H, Wang X, et al. Degradable and bioadhesive alginate-based composites: an effective hemostatic agent. ACS Biomater Sci Eng. 2019;5(10):5498–5505. PMID: 33464069. https://doi.org/10.1021/acsbiomaterials.9b01120

9. Tompeck AJ, Gajdhar AUR, Dowling M, et al. A comprehensive review of topical hemostatic agents: the good, the bad, and the novel. J Trauma Acute Care Surg. 2020;88(1):e1–e21. PMID: 31626024. https://doi.org/10.1097/TA.0000000000002508

10. Lipatov VA, Lazarenko SV, Severinov DA, Denisov AA, Chupakhin EG, Aniskina EN. Comparative analysis of efficacy of the new local hemostatic agents. Extreme Medicine. 2023;25(4):131–136. (In Russ.). https://doi.org/10.47183/mes.2023.063

11. Simpson A, Shukla A, Brown AC. Biomaterials for hemostasis. Annu Rev Biomed Eng. 2022;24:111–135. PMID: 35231178. PMCID: PMC9177659. https://doi.org/10.1146/annurev-bioeng-012521-101942

12. Ismailov BA, Sadykov RA, Kim OV. Hemostatic implant based on cellulose derivates. Experimental and Clinical Gastroenterology. 2019;(9):56–61. (In Russ.). https://doi.org/10.31146/1682-8658-ecg-169-9-56-61

13. Lipatov VA, Lazarenko SV, Severinov DA, Ushanov AA. Study of the special features of the surface of application hemostatic implants. Journal of Experimental and Clinical Surgery. 2019;12(4):261–265. (In Russ.). https://doi.org/10.18499/2070-478x-2019-12-4-261-265

14. Legon’kova OA, Vasil’ev VG,Asanova LYu. Investigation of polymeric wound dressings’ operational properties. Wounds and Wound Infections. The Prof. B.M. Kostyuchenok Journal. 2015;2(2):32–39. (In Russ.). https://doi.org/10.17650/2408-9613-2015-2-2-32-39

15. Lu X, Li X, Yu J, Ding B. Nanofibrous hemostatic materials: structural design, fabrication methods, and hemostatic mechanisms. Acta Biomater. 2022;154:49–62. PMID: 36265792. https://doi.org/10.1016/j.actbio.2022.10.028

16. Brown KGM, Solomon MJ. Topical haemostatic agents in surgery. Br J Surg. 2024;111(1):znad361. PMID: 38156466. PMCID: PMC10771136. https://doi.org/10.1093/bjs/znad361